Provider Demographics
NPI:1578623500
Name:GLUCK, LYNDA D (MA)
Entity Type:Individual
Prefix:
First Name:LYNDA
Middle Name:D
Last Name:GLUCK
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 480184
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90048-1184
Mailing Address - Country:US
Mailing Address - Phone:323-851-6556
Mailing Address - Fax:323-851-6593
Practice Address - Street 1:1728 LAUREL CANYON BLVD
Practice Address - Street 2:D
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90046-2138
Practice Address - Country:US
Practice Address - Phone:323-851-6556
Practice Address - Fax:323-851-6593
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAU64231H00000X
CAHA934237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Not Answered237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAHA00093400Medicaid